Archived: Aamina Homecare Ltd

Updated 13 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection commenced on 12 and 13 April 2017 and was unannounced.

Before the inspection, we contacted the local authority commissioning and safeguarding teams to gain their views on the service.

The registered provider had not yet been asked to complete a Provider Information Return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. However, we checked our systems for any notifications that had been sent in as these would tell us how the registered provider managed incidents and accidents that affected the welfare of people who used the service.

During the inspection we spoke with seven people who used the service and two of their relatives. We also spoke with the registered manager, administrative and office staff, a care support officer and three members of staff.

We looked at 17 people's care plans along with the associated risk assessments and medication administration records (MARs). We also looked at how the service used the Mental Capacity Act 2005 to ensure that when people were assessed as lacking capacity to make informed decisions themselves or when they were deprived of their liberty, actions were taken in their best interest.

We also checked a selection of documentation pertaining to the management and running of the service. This included training records, recruitment information for three members of staff, complaints information and a number of the registered provider’s policies and quality assurance questionnaires.

Updated 13 September 2017

Aamina Homecare Ltd is a domiciliary care agency that provides home care services within North Lincolnshire, North East Lincolnshire and Lincolnshire.

This unannounced comprehensive inspection took place on 12 and 13 April 2017.

After the inspection the Care Quality Commission were notified of an incident following which a person who used the service died. This incident is subject to an on-going investigation.

The inspection was carried out by one adult social care inspector. At the last inspection of the service in April 2015 the service was rated as ‘Good’ overall. The responsive key question was rated as ‘Requires Improvement’.

There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this comprehensive inspection we found multiple breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 and a breach of the Health and Social Care Act 2008 [Registration] Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider's registration of the service, will be inspected again within six months. The expectation is that registered providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People did not receive safe care and support. We saw that staff failed to stay for adequate times to deliver the care and support people had been assessed as requiring safely. Call monitoring data showed people assessed as requiring 30 minutes of support received their care in six minutes or less. A person who required support for 45 minutes had their care delivered in six minutes. People who had been assessed as requiring the support of two staff to help them transfer and mobilise safely regularly received support from only one member of staff, this increased known risks such as falls. People did not receive their medicines safely or as prescribed. One person had been prescribed specific medicines that required a four hour gap between each administration. The registered provider had failed to ensure suitable gaps between their calls and subsequently staff had administered the medicines in an unsafe way.

People were not safeguarded from abuse by way of neglect. Call monitoring records showed and people we spoke with told us they experienced missed calls. This meant vulnerable people did not receive the basic care and support they required such as personal care, assistance to take prescribed medicines, mobilising and transferring and meal preparation. We saw evidence that confirmed appropriate action was not taken when safeguarding concerns were raised or when allegations of abuse were made.

The registered provider failed to ensure governance systems were in place and operated effectively. Care records, were not audited or reviewed to ensure they remained accurate and provided suitable information to enable staff to deliver effective care. This led to shortfalls in care and inadequate risk management.

People did not receive person centred care. We look at 17 people’s care records and found that appropriate guidance was not available to ensure staff could meet their needs. People preferences for how their care and support was to be provided was not recorded. Two people’s needs had not been assessed at the commencement of their care package which meant the registered provider was not fully aware of their needs.

Consent to care and treatment was not always in place and the principles of the Mental Capacity Act 2005 were not followed or adhered to. When people lacked capacity best interest meetings were not held and best interest decisions were not in place to deliver the care people required. During our discussions with staff it was clear their understanding of their obligations under the Act was limited.

Records showed that when complaints were received they were responded to with a generic letter. Complaints were not used to drive improvement across the service and prevent other people experiencing the same issues.

People were supported by care staff before the registered provider had assured themselves of their fitness to work with vulnerable people. Safe recruitment practise were not operated.

People were not always treated with dignity and respect. Staff failed to attend calls at agreed times and people were made to wait for the care and support they required. Private and sensitive information was not held confidentially and information about people’s health was shared inappropriately.

The Care Quality Commission was not notified of specific events, namely allegations of abuse, as required under regulation.

The registered provider failed to display ratings either in their premises or on their website, as required under regulation.

People did not receive effective care and support. The people who required support to prepare meals did not always receive this due to late and missed calls. When concerns with people’s dietary intake were identified appropriate action was not taken. People received support from a range of healthcare professionals but we saw their advice and guidance was not incorporated into people’s care records and there was no evidence to show staff had carried out their instructions. Staff told us they received the training and support they required to carry out their roles.

People did not always receive the support they required in a caring way. People were not always supported by caring staff. The actions of the registered provider prevented supportive relationships being developed by staff and the people who used the service and person centred care being delivered. Call monitoring records showed one person was supported by 19 different carers in a single month. Staff action’s exposed people to the risk of neglect.